ArticleJournal of medical ethics2022
Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation.
Article in Journal of medical ethics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus.Critical care (London, England) · 2024Guideline
- Neuroprognostication After Cardiac Arrest: From Test-Centered Prediction to Ethically Constrained, Longitudinal Decision-Making.Neurocritical care · 2026Article
- Expectations before periacetabular osteotomy and relation to post-operative outcomes and satisfaction.Journal of hip preservation surgery · 2026Article
- Article
- Changes in diagnostic and care trajectories following use of continuous EEG monitoring for neuroprognostication after out of hospital cardiac arrest - a before-and-after study.Resuscitation plus · 2026Article
- Large-scale automated phenotyping of cardiac arrest and withdrawal of life-sustaining therapy using electronic health record data.Resuscitation · 2026Article
- Withdrawal of life-sustaining therapies after cardiac arrest.Current opinion in critical care · 2025Review
- Association of the ICH Score With Withdrawal of Life-Sustaining Treatment Over a 10-Year Period.Annals of clinical and translational neurology · 2025Article
- Genetic tests as prophecy: understanding self-defeating and self-fulfilling mechanisms in (predictive) genetic testing.European journal of human genetics : EJHG · 2025Review
- Estimating bias from withdrawal of life sustaining treatment in clinical trials.Critical care (London, England) · 2025Review
- Review
- Ethically Translating Advanced Neurotechnologies for Disorders of Consciousness: A Survey of Clinicians' Perspectives.Neurocritical care · 2025Article
- Can an accurate model be bad?Patterns (New York, N.Y.) · 2025Article
- Timing of neuroprognostication in the ICU.Current opinion in critical care · 2025Review
- Recovery Potential in Patients After Cardiac Arrest Who Die After Limitations or Withdrawal of Life Support.JAMA network open · 2025Article
- Assessing Risk in Implementing New Artificial Intelligence Triage Tools-How Much Risk is Reasonable in an Already Risky World?Asian bioethics review · 2025Article
- Neuron-Specific Enolase as a Predictor of Neurologic Outcomes in Extracorporeal Cardiopulmonary Resuscitation Patients.Journal of clinical medicine · 2024Article
- A multicenter, randomized, doubleblind, placebo-controlled trial of amantadine to stimulate awakening in comatose patients resuscitated from cardiac arrest.Clinical and experimental emergency medicine · 2024Article
- Prediction of outcomes after cardiac arrest by a generative artificial intelligence model.Resuscitation plus · 2024Article
- Characterizing coma in large vessel occlusion stroke.Journal of neurology · 2024Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A self-fulfilling prophecy (SFP) in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome (viz. death) for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.